Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 1

One and Five Year Outcomes After

Moderate-to-Severe Traumatic Brain Injury

Requiring Inpatient Rehabilitation

TRAUMATIC BRAIN INJURY REPORT
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 2

AUTHORS

Gale G Whiteneck, PhD; CB Eagye, MS; Jeffery P Cuthbert, PhD; John D Corrigan, PhD; Jeneita 

M Bell, MD; Juliet K Haarbauer-Krupa, PhD; A. Cate Miller, PhD; Jessica M Ketchum, PhD; Flora M 

Hammond, MD; Kristen Dams-O’Connor, PhD; Cynthia Harrison-Felix, PhD

AUTHOR AFFILIATIONS: 

Craig Hospital, Englewood, Colorado (Whiteneck, Eagye, Cuthbert, Ketchum, and Harrison-Felix); 

Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio 

(Corrigan); National Center for Injury Prevention and Control, Centers for Disease Control and 

Prevention, Atlanta, Georgia (Bell and Haarbauer-Krupa); Department of Physical Medicine and 

Rehabilitation, Indiana University School of Medicine, Indianapolis, IN (Hammond); Department of 

Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York NY (Dams-O’Connor); 

and Department of Health and Human Services, National Institute on Disability, Independent 

Living and Rehabilitation Research, Washington, District of Columbia (Miller).

This research was supported by an interagency agreement between the U.S. Department of Health and 

Human Services (HHS), Centers for Disease Control and Prevention (CDC), and the U.S. Department of 

Education, National Institute on Disability and Rehabilitation Research (NIDRR) with supplemental funding 

to the NIDRR-funded Traumatic Brain Injury Model Systems National Data and Statistical Center (grant no. 

H133A110006). In 2014, NIDRR was moved from the U.S. Department of Education to the Administration for 

Community Living of the U.S. Department of Health and Human Services, and was renamed the National 

Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). This report does not 

reflect the official policy or opinions of the CDC, NIDILRR or HHS, and does not constitute an endorsement 

of the individuals or their programs—by the CDC, NIDILRR, HHS, or other components of the federal 

government—and none should be inferred. No commercial party having a direct financial interest in the 

results of the research supporting this report has or will confer a benefit upon the authors, or upon any 

organization with which the authors are associated.
Traumatic Brain Injury Report l 3

EXECUTIVE 

SUMMARY
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 4

Traumatic brain injury (TBI) is an important public health concern in the United States. 

Surveys from two states suggest that 20-25% of adults have experienced at least one 

TBI with loss of consciousness sometime in their life.1,2 Approximately 21,400 people 

aged 16 and over receive inpatient rehabilitation in the U.S. annually for moderate-to-severe 

TBI.3,4 This report presents national outcome data about adolescents and adults who receive 

inpatient rehabilitation for a TBI. The estimates in the report are derived from individuals 

injured between 2001 and 2007 in the TBI Model System National Database which follows for 

a lifetime a large sample of people with moderate-to-severe TBI initially treated in inpatient 

rehabilitation. The TBI-related outcomes include a global measure of functional outcome, 

measures of cognitive and motor functioning, and a measure of the level of supervision the 

individual requires after their TBI.* These outcomes are assessed at 1 and 5 years after injury 

and are analyzed for demographic subgroups based on age and sex. 

KEY GLOBAL FUNCTION FINDINGS 

• An estimated 20% of individuals died within 5 years of injury, with higher mortality rates

among older individuals.

• Sixty-one percent of individuals experienced a change in their global function between

1 and 5 years post-injury, with 26% improving and 35% declining or dying. With each

increasing age category, both females and males experienced less improvement and

more decline.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 5

KEY COGNITIVE AND MOTOR FUNCTION AND SUPERVISION 

FINDINGS (Among Those Alive 5 Years Post-Injury) 

• Almost half of individuals experienced a change in their cognitive function between 1 and

5 years post-injury, with 24% improving and 24% declining.

• One-third of individuals experienced change in their need for supervision between 1 and 5

years post-injury, with 17% needing less and 17% needing more.

• There was considerably less change in motor function, with 8% improving and 13%

declining between 1 and 5 years post-injury.

• The pattern of improvement and decline is quite different in age subgroups, with people

aged 16 to 49 showing better outcomes.

• Higher proportions of females age 70 and over experienced decline in cognitive and motor

function than their male counterparts.

CONCLUSIONS

• Useful estimates of outcomes (and changes in outcomes) in the national population of

adults receiving inpatient TBI rehabilitation can be derived from TBI Model System data.

• One-fifth of individuals who receive inpatient rehabilitation for moderate-to-severe TBI die

within 5 years of their injury.

• For those who are alive 5 years after their injury, considerable change in function occurs

over time after TBI, with improvement occurring about as frequently as decline between

1 and 5 years post-injury.

• Older age groups have more decline in all outcomes for both females and males.

HEALTH IMPLICATIONS

• Analysis of change over time within individuals highlights that TBI is a dynamic condition.

• The frequency and magnitude of change after TBI suggests the need for chronic disease

management strategies including systematic prospective follow-up, interventions to

prevent or slow decline in function, and access to continuing rehabilitation to respond to

changing needs.

• Population-based trends in outcomes, analyzed by demographic subgroups (like those in

this publication), may help in planning for the long-term needs of people who receive initial

inpatient rehabilitation for TBI.

Note: * The specific instruments used to measure outcome are described in the next section “Report Methods and Charts.”
Traumatic Brain Injury Report l 6

REPORT METHODS AND CHARTS

The purpose of this report is to describe long-term functional outcomes after moderate-tosevere TBI. The population included in these analyses is people aged 16 and over who receive 

inpatient TBI rehabilitation after TBI in the United States. The time period covered is the 

first 5 years after injury, specifically outcomes at 1 year and 5 years after TBI, and changes in 

outcomes occurring between those two time points. The specific outcomes of interest include 

the following standardized instruments collected in interviews with individuals with TBI or 

their family members/caregivers:

GLOBAL FUNCTION 

• The Glasgow Outcome Scale – Extended (GOS-E)5

 is an ordinal scale that measures global 

function. Patient status was classified into one of eight categories: 

1. Dead

2. Vegetative State (only reflex responses)

3. Lower Severe Disability (needs assistance and cannot be left alone for 8 hours)

4. Upper Severe Disability (needs assistance but can be left alone for 8 hours)

5. Lower Moderate Disability (independent at home but not able to return to work 

even with special arrangements) 

6. Upper Moderate Disability (independent at home and able to return to work with 

special arrangements)

7. Lower Good Recovery (independent with the capacity to work, but minor disability)

8. Upper Good Recovery (independent with the capacity to work and no disability)

LEVEL OF SUPERVISION 

• The Supervision Rating Scale (SRS)6

 is an ordinal scale that measures the level of supervision 

that an individual receives from caregivers, grouped into three categories for this report: 

Independent (no supervision), Overnight/Part-Time Supervision, and Full-Time Supervision

COGNITIVE FUNCTION

• The Cognitive Subscale of the Functional Independence Measure (FIM)®7

 is a seven-level 

ordinal scale sed to rate the ability of individuals to perform independently in activities 

of daily living that includes the following 5 cognitive items:

1. Comprehension

2. Expression

3. Social interaction

4. Problem solving

5. Memory
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 7

• Rating categories and associated scores are:

1. Total Assistance (individual completes task without prompting less than 25% of the time)

2. Maximal Assistance (individual completes task without prompting 25% to 49% of the time)

3. Moderate Assistance (individual completes task without prompting 50 to 74% of the time)

4. Minimal Assistance (individual completes task without prompting 75% to 90% of the time)

5. Supervision (individual completes task without prompting more than 90% of the time)

6. Modified Independence (individual requires use of a device or aid, but no prompting)

7. Independence (no assistance or device)

• Scores in this report are averaged across the 5 items, rounded, and assigned the

corresponding category

MOTOR FUNCTION

• The Motor Subscale of FIM®7

 is a seven-level ordinal scale used to rate the ability of individuals to 

perform independently in activities of daily living that includes the following 13 motor items:

1. Eating

2. Grooming

3. Bathing

4. Dressing, upper body

5. Dressing, lower body

6. Toileting

7. Bladder management

8. Bowel management

9. Transfers - bed/chair/wheelchair

10. Transfers - toilet

11. Transfers - bath/shower

12. Walk/wheelchair

13. Stairs

• Rating categories and associated scores are: 

1. Total Assistance (individual can perform less than 25% of the task or requires more 

than one person to assist)

2. Maximal Assistance (individual can perform 25% to 49% of task)

3. Moderate Assistance (individual can perform 50% to 74% of task)

4. Minimal Assistance (individual can perform 75% or more of task)

5. Supervision (supervision or set-up only)

6. Modified Independence (patient requires use of a device or aid, but no physical assistance)

7. Independence (no assistance or device)

• Scores in this report are averaged across the 13 items, rounded, and assigned the 

corresponding category 
Traumatic Brain Injury Report l 8

Data used in preparing this report came from two sources. Information about the number 

and characteristics of people receiving inpatient TBI rehabilitation in the U.S. are collected by 

the Uniform Data System for Medical Rehabilitation and the American Medical Rehabilitation 

Providers Association’s eRehabData, which together gather data on all inpatients seen in over 

90% of the rehabilitation facilities in the U.S. Information about the characteristics and longterm outcomes of people receiving inpatient TBI rehabilitation are collected by 20 federally 

designated TBI Model Systems (TBIMS) around the U.S., which enroll a large sample of cases in 

the TBIMS National Database (NDB) and follow them at 1, 2, and 5 years after injury (and every 

5 years thereafter) and assesses a range of patient outcomes. Individuals aged 16 and over 

who received inpatient TBI rehabilitation between Oct 1, 2001 and Dec 31, 2007 were selected 

from these datasets for analysis. The 4,788 patients from the TBIMS NDB were followed for 

five years and were weighted to represent the 99,339 patients in the national population. The 

sophisticated procedures used to weight the TBIMS cases are detailed in the Methodological 

Appendix. These procedures allowed the known 1 and 5 year outcomes of the TBIMS cases to 

be used to estimate outcomes for all individuals in the U.S. receiving inpatient TBI rehabilitation. 

These best estimates of outcomes after inpatient TBI rehabilitation in the U.S. are presented in 

this report using 5 charts per outcome:

• Chart 1: Labeled Distribution of [Outcome] at 1 and 5 Years Post-Injury, this chart shows the 

proportion of each category within an outcome for the population at one year (in the left 

column) and five years (in the right column)

• Chart 2: Labeled Change in [Outcome] from Year 1 to Year 5 Post-Injury, this chart shows the 

proportion of people in the population who improved or declined from one category to 

another

• Charts 3 and 4: Labeled Distribution of [Outcome]: for Females/Males at 1 and 5 Years PostInjury, these charts show the same information as Chart 1 but stratify outcomes by the sex 

of the patient. On their respective charts, female and male individuals are further divided into 

age groups at injury: 16-29, 30-49, 50-69, and 70+

• Chart 5: Labeled Change in [Outcome] by Sex and Age from Year 1 to Year 5 Post-Injury, 

this chart shows the same information as Chart 2 divided into sex and age subgroups 

in the same manner as Chart 3

Note that the charts for global function include all individuals, whether they survived or 

not. However, charts for supervision and cognitive and motor function are limited to those 

individuals who survived to at least their 5th anniversary of injury. By limiting both the 1 and 

5 year data to 5 year survivors, the same cases are included at both time points, making the 

comparisons more valid.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 9

GLOBAL 

FUNCTION
Traumatic Brain Injury Report l 10

DISTRIBUTION OF GLOBAL FUNCTION CATEGORIES 

AT 1 AND 5 YEARS AFTER MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION YEAR 1 YEAR 5

Upper Good Recovery 25.1% 26.1%

Lower Good Recovery 13.2% 8.8%

Upper Moderate Disability 13.3% 11.1%

Lower Moderate Disability 8.9% 6.5%

Upper Severe Disability 15.4% 10.3%

Lower Severe Disability 17.8% 16.8%

Vegetative State 0.3% 0.4%

Dead 6.1% 20.0%

This chart depicts the comparison of Year 1 and Year 5 global function category frequencies for the population. 

The bar on the left indicates that 25.1% of individuals were in the Upper Good Recovery category at 1 year 

post-injury, while 6.1% had died. As shown in the bar on the right, a similar proportion (26.1%) were in the 

top recovery category at 5 years post-injury, but 20.0% had died in the first 5 years after injury.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 11

CHANGE IN GLOBAL FUNCTION FROM YEAR 1 TO YEAR 5 

AFTER MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

CHANGE 

YEAR 1 TO 5

Improved 4+ Categories 2.1%

Improved 2-3 Categories 10.4%

Improved 1 Category 13.4%

No Category Change 39.0%

Declined 1 Category 11.8%

Declined 2-3 Categories 14.1%

Declined 4+ Categories 9.1%

This chart depicts the proportion of the population that improved or declined from Year 1 to Year 5 in global 

function. Between years 1 and 5, 39.0% of individuals experienced no change in GOS-E category. Slightly more 

individuals declined 1 to 3 categories (25.9%) than improved 1 to 3 categories (23.8%). The proportion of 

individuals who declined 4 or more categories (9.1%) was more than 4 times greater than the proportion 

who improved 4 or more categories (2.1%).

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 12

DISTRIBUTION OF GLOBAL FUNCTION FOR FEMALES BY AGE 

AT 1 AND 5 YEARS AFTER MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16 - 29

 YEAR 1

FEMALE 

16 - 29 

YEAR 5

FEMALE 

30 - 49 

YEAR 1

FEMALE 

30 - 49 

YEAR 5

FEMALE 

50 - 69 

YEAR 1

FEMALE 

50 - 69 

YEAR 5

FEMALE 

70+ 

YEAR 1

FEMALE 

70+ 

YEAR 5

Upper Good Recovery 29.9% 45.4% 17.5% 23.0% 23.3% 26.8% 21.4% 20.1%

Lower Good Recovery 17.7% 15.8% 13.1% 5.7% 14.7% 9.6% 14.4% 4.9%

Upper Moderate Disability 20.3% 18.4% 24.5% 33.5% 11.3% 8.5% 2.3% 1.7%

Lower Moderate Disability 8.3% 6.6% 11.7% 12.7% 8.4% 8.2% 6.1% 0.0%

Upper Severe Disability 13.6% 4.0% 16.4% 8.0% 15.9% 9.1% 21.0% 19.9%

Lower Severe Disability 8.7% 7.8% 13.4% 7.5% 22.0% 21.6% 26.5% 25.1%

Vegetative State 1.5% .9% .2% 0.0% 0.0% 0.0% 0.0% 0.0%

Dead .1% 1.2% 3.2% 9.5% 4.5% 16.3% 8.2% 28.2% 

This chart depicts the comparison of Year 1 and Year 5 global function for the female population by age 

subgroups. Lighter shades of blue represent better outcomes than darker shades of blue; black shading 

represents death.

Improvement was demonstrated by a higher proportion of the youngest age females (16-29) compared to 

older age females. At Year 5, the highest proportion of Upper Good Recovery is among females age 16-29 

(45.4%). At Year 5, the highest rate of death is 28.2% among females age 70 and over.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 13

DISTRIBUTION OF GLOBAL FUNCTION FOR MALES BY 

AGE AT 1 AND 5 YEARS AFTER MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

MALE 

16 - 29

 YEAR 1

MALE 

16 - 29 

YEAR 5

MALE 

30 - 49 

YEAR 1

MALE 

30 - 49 

YEAR 5

MALE 

50 - 69 

YEAR 1

MALE 

50 - 69 

YEAR 5

MALE 

70+ 

YEAR 1

MALE 

70+ 

YEAR 5

Upper Good Recovery 32.8% 40.5% 18.4% 24.8% 21.5% 23.9% 30.8% 22.5%

Lower Good Recovery 15.9% 18.6% 14.3% 10.1% 13.3% 8.7% 8.7% 5.3%

Upper Moderate Disability 22.7% 18.6% 24.1% 19.5% 16.2% 15.2% 6.8% 3.6%

Lower Moderate Disability 8.2% 7.0% 14.7% 20.2% 12.6% 9.7% 5.7% .7%

Upper Severe Disability 8.9% 5.2% 13.7% 8.9% 12.6% 10.6% 16.6% 7.1%

Lower Severe Disability 10.5% 7.4% 12.8% 9.1% 18.5% 15.9% 18.6% 21.8%

Vegetative State .9% .5% .6% .4% 0.0% .7% 0.0% .5%

Dead .1% 2.2% 1.4% 7.1% 5.3% 15.2% 12.8% 38.5%

This chart depicts the comparison of Year 1 and Year 5 global function in the male population by age 

subgroups. Lighter shades of blue represent better outcomes than darker shades of blue; black shading 

represents death. 

As with females, improvement was demonstrated by a higher proportion of the youngest age males (16-29) 

compared to older age males. At Year 5, the highest proportion of Upper Good Recovery is among males age 

16-29 (40.5%). At Year 5, the highest rate of death is 38.5% among males age 70 and over. 

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 14

CHANGE IN GLOBAL FUNCTION BY SEX AND AGE FROM 

YEAR 1 TO YEAR 5 AFTER MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16-29 

YR 1 TO 5

FEMALE 

30-49 

YR 1 TO 5

FEMALE 

50-69 

YR 1 TO 5

FEMALE 

70+ 

YR 1 TO 5

MALE 

16-29 

YR 1 TO 5

MALE 

30-49 

YR 1 TO 5

MALE 

50-69 

 YR 1 TO 5

MALE 

70+ 

YR 1 TO 5

Improved 4+ Categories 3.1% 1.6% 3.0% 3.7% 2.2% 1.4% 2.0% .6%

Improved 2-3 Categories 18.4% 15.7% 11.5% 6.1% 17.7% 13.5% 10.7% 5.5%

Improved 1 Category 20.7% 20.3% 16.7% 10.6% 20.7% 19.2% 12.0% 6.0%

No Category Change 41.1% 40.9% 39.4% 35.4% 37.2% 39.2% 44.5% 38.9%

Declined 1 Category 11.4% 9.7% 6.7% 9.6% 14.2% 13.7% 13.2% 12.2%

Declined 2-3 Categories 4.9% 7.3% 13.9% 16.2% 6.5% 8.8% 10.7% 24.7%

Declined 4+ Categories .4% 4.5% 8.8% 18.4% 1.5% 4.1% 6.9% 12.1%

This chart depicts the proportion of the population who improved or declined in global function from Year 

1 to Year 5, divided into sex and age subgroups. With each increasing age category, both females and males 

experienced less improvement and more decline in global function. Males age 70 and over experienced the 

greatest decline, with 12.2% declining 1 category and 36.8% declining 2 or more categories. Similarly, 9.6% 

of females age 70 and over saw a 1 category decline, with 34.6% declining 2 or more categories.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 15

LEVEL OF

SUPERVISION
Traumatic Brain Injury Report l 16

DISTRIBUTION OF SUPERVISION AT 1 AND 5 YEARS 

POST-INJURY AMONG 5-YEAR SURVIVORS OF MODERATETO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION YEAR 1 YEAR 5

Independent 55.7% 57.6%

Overnight/PT Supervision 32.2% 27.1%

FT Supervision 12.1% 15.3%

This chart depicts the comparison of level of supervision at Year 1 and Year 5 in the population (alive at 5 years 

post-injury). The bar on the left indicates that 55.7% of individuals were in the independent category at 1 year 

post-injury, while 12.1% needed full-time (FT) supervision. As shown in the bar on the right, there was a slight 

increase in the proportion of individuals classified as independent (57.6%) at 5 years post-injury, as well as an 

increase in those requiring FT supervision (15.3%) but a decrease in those requiring overnight or part-time 

supervision (from 32.2% to 27.1%).

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 17

CHANGE IN SUPERVISION FROM YEAR 1 TO YEAR 5 

POST-INJURY AMONG 5-YEAR SURVIVORS OF MODERATETO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

CHANGE 

YEAR 1 TO 5 

Improved 2 Categories 0.9%

Improved 1 Category 16.4%

No Category Change 65.6%

Declined 1 Category 14.3%

Declined 2 Categories 2.8%

This chart depicts the proportion of the population (alive at 5 years post-injury) that improved or declined 

change in their need for supervision from Year 1 to Year 5. Between years 1 and 5, the majority of individuals 

(65.6%) experienced no change in the need for supervision. Slightly more individuals improved 1 category 

(16.4%) than declined 1 category (14.3%), yet 2.8% of individuals declined 2 categories, whereas only 0.9% 

improved 2 categories.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 18

DISTRIBUTION OF SUPERVISION FOR FEMALES BY AGE 

AT 1 AND 5 YEARS POST-INJURY AMONG 5-YEAR SURVIVORS*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16 - 29

 YEAR 1

FEMALE 

16 - 29 

YEAR 5

FEMALE 

30 - 49 

YEAR 1

FEMALE 

30 - 49 

YEAR 5

FEMALE 

50 - 69 

YEAR 1

FEMALE 

50 - 69 

YEAR 5

FEMALE 

70+ 

YEAR 1

FEMALE 

70+ 

YEAR 5

Independent 57.7% 77.9% 58.5% 74.0% 45.4% 53.7% 44.6% 32.5%

Overnight/PT Supervision 36.4% 18.3% 34.6% 20.9% 38.8% 26.2% 38.3% 40.1%

FT Supervision 5.9% 3.8% 6.9% 5.1% 15.8% 20.1% 17.1% 27.4%

This chart depicts the comparison of need for supervision at Year 1 and Year 5 in the female population (alive 

at 5 years post-injury), divided into age subgroups. Lighter colors indicate better outcomes than darker ones. 

As illustrated by the color patterns, younger females were more independent than older females. The highest 

proportion of independent females was age 16-29 at Year 5 (77.9%), followed by females at age 30-49, also 

at Year 5 (74.0%). 

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 19

DISTRIBUTION OF SUPERVISION FOR MALES BY AGE AT 

1 AND 5 YEARS POST-INJURY AMONG 5-YEAR SURVIVORS*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

MALE 

16 - 29

 YEAR 1

MALE 

16 - 29 

YEAR 5

MALE 

30 - 49 

YEAR 1

MALE 

30 - 49 

YEAR 5

MALE 

50 - 69 

YEAR 1

MALE 

50 - 69 

YEAR 5

MALE 

70+ 

YEAR 1

MALE 

70+ 

YEAR 5

Independent 64.4% 77.8% 58.5% 65.4% 61.3% 59.3% 54.8% 48.7%

Overnight/PT Supervision 27.8% 17.2% 32.4% 28.8% 25.8% 27.7% 30.8% 24.9%

FT Supervision 7.7% 5.0% 9.2% 5.8% 12.9% 13.1% 14.3% 26.3%

This chart depicts the comparison of need for supervision at Year 1 and Year 5 in the male population (alive 

at 5 years post-injury), divided into age subgroups. Lighter colors indicate better outcomes than darker ones. 

As illustrated by the color patterns, younger males were more independent than older males. The highest 

proportion of independent males was age 16-29 at Year 5 (77.8%). In general, the proportion of independent 

males was equal to or greater than the proportion of independent females at 1 and 5 years post-injury across 

all age groups except for age 30-49 at 5 years post-injury; a lower proportion of males were independent 

(65.4%) than females (74.0%).

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 20

CHANGE IN SUPERVISION BY SEX AND AGE FROM YEAR 1 

TO YEAR 5 POST-INJURY AMONG 5-YEAR SURVIVORS OF 

MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16-29 

YR 1 TO 5

FEMALE 

30-49 

YR 1 TO 5

FEMALE 

50-69 

YR 1 TO 5

FEMALE 

70+ 

YR 1 TO 5

MALE 

16-29 

YR 1 TO 5

MALE 

30-49 

YR 1 TO 5

MALE 

50-69 

 YR 1 TO 5

MALE 

70+ 

YR 1 TO 5

Improved 2 Categories 1.1% 1.6% 0.5% 1.3% 1.2% 0.8% 0.3% 0.8%

Improved 1 Category 25.3% 23.5% 19.2% 10.4% 19.2% 17.8% 13.4% 15.8%

No Category Change 68.3% 63.9% 64.1% 59.4% 74.7% 72.4% 72.7% 53.0%

Declined 1 Category 5.2% 11.0% 14.9% 20.7% 4.9% 8.9% 11.0% 26.4%

Declined 2 Categories 0.1% 0.0% 1.3% 8.2% 0.1% 0.1% 2.7% 3.9%

This chart depicts the proportion of the population (alive at 5 years post-injury) that improved or declined 

in supervision requirements from Year 1 to Year 5, divided into sex and age subgroups. Over 60% of females 

younger than age 70 experienced no change in supervision requirements, and over 70% of males under the 

age of 70 experienced no change. However, as the graph colors illustrate, among those who did experience 

a change, older age groups saw more decline than younger ones for both males and females.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 21

COGNITIVE 

FUNCTION
Traumatic Brain Injury Report l 22

DISTRIBUTION OF COGNITIVE FUNCTION AT 1 AND 5 YEARS 

POST-INJURY AMONG 5-YEAR SURVIVORS OF MODERATETO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION YEAR 1 YEAR 5

Independence 51.4% 51.9%

Modified Independence 29.8% 29.6%

Supervision 10.3% 7.1%

Minimal Assistance 4.7% 4.2%

Moderate Assistance 1.5% 3.4%

Maximal Assistance 1.3% 1.7%

Total Assistance 1.0% 2.1%

This chart depicts the comparison of Year 1 and Year 5 cognitive function in the population (alive at 5 years 

post-injury). The bar on the left indicates that 81.2% of individuals were either independent (51.4%) or had 

modified independence (29.8%) at 1 year post-injury, with 8.5% needing assistance beyond supervision. 

As shown in the bar on the right, at Year 5 there was virtually no change in the proportion of individuals who 

were independent (51.9%) or had modified independence (29.6%), with a slightly larger proportion (11.4%) 

needing assistance.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 23

CHANGE IN COGNITIVE FUNCTION FROM YEAR 1 TO YEAR 5 

POST-INJURY AMONG 5-YEAR SURVIVORS OF MODERATETO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

CHANGE 

YEAR 1 TO 5

Improved 4+ Categories 0.3%

Improved 2-3 Categories 4.8%

Improved 1 Category 18.6%

No Category Change 52.3%

Declined 1 Category 15.7%

Declined 2-3 Categories 6.3%

Declined 4+ Categories 2.0% 

This chart depicts the proportion of the population (alive at 5 years post-injury) that improved or declined 

categories from Year 1 to Year 5 in cognitive function. Between years 1 and 5, nearly half of all individuals 

(47.7%) experienced change in cognitive function. Slightly more individuals improved 1 category (18.6%) than 

declined 1 category (15.7%), yet slightly fewer individuals improved 2 or more categories (5.1%) than declined 

2 or more categories. Overall, individuals who experienced a change in cognitive function were almost equally 

split between improvement (23.7%) and decline (24.0%).

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 24

DISTRIBUTION OF COGNITIVE FUNCTION FOR FEMALES 

BY AGE AT 1 AND 5 YEARS POST-INJURY AMONG 5-YEAR 

SURVIVORS OF MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16 - 29

 YEAR 1

FEMALE 

16 - 29 

YEAR 5

FEMALE 

30 - 49 

YEAR 1

FEMALE 

30 - 49 

YEAR 5

FEMALE 

50 - 69 

YEAR 1

FEMALE 

50 - 69 

YEAR 5

FEMALE 

70+ 

YEAR 1

FEMALE 

70+ 

YEAR 5

Independence 55.2% 67.8% 42.7% 46.9% 44.1% 45.5% 55.2% 38.1%

Modified Independence 32.5% 24.4% 42.7% 44.6% 32.2% 31.8% 27.5% 37.8%

Supervision 8.6% 4.7% 9.0% 3.6% 9.2% 11.0% 6.2% 8.3%

Minimal Assistance 1.6% 1.2% 4.7% 4.5% 5.4% 0.8% 8.1% 4.5%

Moderate Assistance 0.8% 0.7% 0.9% 0.4% 6.6% 7.9% 2.0% 5.9%

Maximal Assistance 0.2% 0.1% 0.0% 0.0% 0.2% 2.3% 0.0% 4.1%

Total Assistance 1.1% 1.1% 0.0% 0.0% 2.3% 0.6% 1.1% 1.4%

This chart depicts the comparison of Year 1 and Year 5 cognitive function in the female population (alive at 5 

years post-injury), divided into age subgroups. Lighter colors indicate better outcomes than darker ones. 

As illustrated by the color patterns, most females were independent or had modified independence regardless 

of age or year post-injury. The proportion requiring assistance was higher among females age 50 and over. 

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 25

DISTRIBUTION OF COGNITIVE FUNCTION FOR MALES 

BY AGE AT 1 AND 5 YEARS POST-INJURY AMONG 5-YEAR 

SURVIVORS OF MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

MALE 

16 - 29

 YEAR 1

MALE 

16 - 29 

YEAR 5

MALE 

30 - 49 

YEAR 1

MALE 

30 - 49 

YEAR 5

MALE 

50 - 69 

YEAR 1

MALE 

50 - 69 

YEAR 5

MALE 

70+ 

YEAR 1

MALE 

70+ 

YEAR 5

Independence 61.1% 66.7% 47.1% 51.8% 52.0% 51.7% 46.4% 51.9%

Modified Independence 25.4% 24.6% 31.8% 31.9% 28.2% 26.3% 30.5% 23.3%

Supervision 7.1% 4.5% 14.0% 11.6% 13.1% 8.3% 12.8% 3.4%

Minimal Assistance 3.0% 1.8% 3.5% 2.4% 2.7% 7.7% 6.5% 6.9%

Moderate Assistance 1.3% 1.3% 1.6% 2.0% 1.2% 3.1% 0.0% 4.5%

Maximal Assistance 0.8% 0.3% 0.8% 0.3% 1.8% 1.3% 3.9% 2.6%

Total Assistance 1.4% 0.9% 1.3% 0.1% 1.0% 1.7% 0.0% 7.4% 

This chart depicts the comparison of Year 1 and Year 5 cognitive function in the male population (alive at 5 

years post-injury), divided into age subgroups. Lighter colors indicate better outcomes than darker ones. 

As illustrated by the color patterns, most males were independent or had modified independence regardless 

of age or year post-injury. The proportion of males requiring supervision or assistance was lower among males 

under age 30. 

 *Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 26

CHANGE IN COGNITIVE FUNCTION BY SEX AND AGE FROM 

1 TO 5 YEARS POSTINJURY AMONG 5-YEAR SURVIVORS 

OF POST-INJURY TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16-29 

YR 1 TO 5

FEMALE 

30-49 

YR 1 TO 5

FEMALE 

50-69 

YR 1 TO 5

FEMALE 

70+ 

YR 1 TO 5

MALE 

16-29 

YR 1 TO 5

MALE 

30-49 

YR 1 TO 5

MALE 

50-69 

 YR 1 TO 5

MALE 

70+ 

YR 1 TO 5

Improved 4+ Categories 0.0% 0.0% 0.4% 0.0% 0.8% 0.4% 0.4% 0.0%

Improved 2-3 Categories 3.9% 5.3% 3.7% 2.4% 5.2% 6.1% 2.2% 8.2%

Improved 1 Category 22.6% 19.8% 19.1% 18.3% 17.3% 21.0% 14.8% 19.0%

No Category Change 61.6% 57.6% 55.7% 37.1% 63.7% 54.7% 58.6% 45.1%

Declined 1 Category 10.8% 15.2% 18.4% 27.5% 11.4% 15.0% 15.9% 9.3%

Declined 2-3 Categories 0.8% 2.0% 1.6% 8.8% 1.4% 2.7% 7.4% 14.8%

Declined 4+ Categories 0.4% 0.0% 1.1% 6.0% 0.1% 0.0% 0.7% 3.5%

This chart depicts the proportion of the population (alive at 5 years post-injury) that improved or declined in 

cognitive function from Year 1 to 5, divided into sex and age subgroups. Females age 70 and over experienced 

the greatest decline in cognitive function, with 27.5% declining 1 category and 14.8% declining 2 or more 

categories. By contrast, 9.3% of males age 70 and over saw a 1 category decline, with 18.3% declining 2 or 

more categories. 

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 27

MOTOR 

FUNCTION
Traumatic Brain Injury Report l 28

DISTRIBUTION OF MOTOR FUNCTION AT 1 AND 5 YEARS 

POST-INJURY AMONG 5-YEAR SURVIVORS OF MODERATETO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION YEAR 1 YEAR 5

Independence 83.2% 76.6%

Modified Independence 8.3% 9.2%

Supervision 4.1% 4.9%

Minimal Assistance 1.2% 2.6%

Moderate Assistance 1.1% 2.1%

Maximal Assistance 1.4% 3.5%

Total Assistance 0.7% 1.1%

This chart depicts the comparison of Year 1 and Year 5 motor function in the population (alive at 5 years postinjury). The bar on the left indicates that 83.2% of individuals were independent at 1 year post-injury, with 

4.4% needing assistance beyond supervision. As shown in the bar on the right, at Year 5 the independent 

group had dropped to 76.6%, with people requiring assistance beyond supervision increasing to 9.3%.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 29

CHANGE IN MOTOR FUNCTION FROM YEAR 1 TO YEAR 5 

POST-INJURY AMONG 5-YEAR SURVIVORS OF MODERATETO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

CHANGE 

YEAR 1 TO 5

Improved 4+ Categories 0.4%

Improved 2-3 Categories 2.0%

Improved 1 Category 5.4%

No Category Change 79.1%

Declined 1 Category 7.3%

Declined 2-3 Categories 2.7%

Declined 4+ Categories 3.0%

This chart depicts the proportion of the population (alive at 5 years post-injury) that improved or declined in 

motor function from Year 1 to Year 5. Between years 1 and 5, the majority of individuals (79.1%) experienced 

no change in motor function. Slightly more individuals declined 1 category (7.3%) than improved 1 category 

(5.4%), with 5.7% of individuals declining 2 or more categories and 2.4% improving 2 or more categories. 

Overall, 13.0% declined and 7.8% improved.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 30

DISTRIBUTION OF MOTOR FUNCTION FOR FEMALES BY AGE 

AT 1 AND 5 YEARS POST-INJURY AMONG 5-YEAR SURVIVORS 

OF MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16 - 29

 YEAR 1

FEMALE 

16 - 29 

YEAR 5

FEMALE 

30 - 49 

YEAR 1

FEMALE 

30 - 49 

YEAR 5

FEMALE 

50 - 69 

YEAR 1

FEMALE 

50 - 69 

YEAR 5

FEMALE 

70+ 

YEAR 1

FEMALE 

70+ 

YEAR 5

Independence 91.2% 91.8% 86.6% 92.7% 83.8% 82.6% 71.1% 47.3%

Modified Independence 2.5% 4.7% 7.7% 4.8% 7.9% 7.5% 18.6% 24.5%

Supervision 2.7% 1.3% 2.5% 1.1% 2.0% 4.1% 5.3% 8.0%

Minimal Assistance 0.8% 0.2% 0.7% 0.7% 2.3% 1.4% 1.3% 7.8%

Moderate Assistance 0.5% 0.6% 1.0% 0.0% 0.3% 1.0% 1.7% 5.3%

Maximal Assistance 1.2% 0.1% 1.4% 0.7% 3.7% 3.4% 1.0% 6.1%

Total Assistance 1.1% 1.3% 0.0% 0.0% 0.0% 0.0% 1.1% 0.9%

This chart depicts the comparison of Year 1 and Year 5 motor function in the female population (alive at 

5 years post-injury), divided into age subgroups. Lighter colors indicate better outcomes than darker ones. 

As illustrated by the color patterns, most females were independent or had modified independence regardless 

of age or years post-injury. Less than 10% of females under age 70 needed supervision or assistance due to 

decreased motor function either at 1 or 5 years post-injury. Among females age 70 and over, the proportion 

needing supervision or assistance due to motor function was 10.4% at Year 1 and 28.1% at Year 5. 

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 31

DISTRIBUTION OF MOTOR FUNCTION FOR MALES BY AGE 

AT 1 AND 5 YEARS POST-INJURY AMONG 5-YEAR SURVIVORS 

OF MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

MALE 

16 - 29

 YEAR 1

MALE 

16 - 29 

YEAR 5

MALE 

30 - 49 

YEAR 1

MALE 

30 - 49 

YEAR 5

MALE 

50 - 69 

YEAR 1

MALE 

50 - 69 

YEAR 5

MALE 

70+ 

YEAR 1

MALE 

70+ 

YEAR 5

Independence 89.5% 93.5% 87.6% 89.7% 88.2% 82.8% 78.2% 64.4%

Modified Independence 4.1% 2.0% 6.9% 5.7% 5.2% 5.8% 7.5% 8.6%

Supervision 0.8% 1.4% 1.3% 1.7% 1.1% 4.8% 12.7% 10.0%

Minimal Assistance 1.8% 0.7% 0.8% 0.5% 1.1% 2.1% 0.8% 2.9%

Moderate Assistance 1.2% 1.0% 1.1% 0.7% 1.2% 0.4% 0.8% 3.9%

Maximal Assistance 1.4% 0.6% 1.3% 1.0% 2.6% 3.6% 0.0% 7.5%

Total Assistance 1.1% 0.8% 1.1% 0.7% 0.7% 0.4% 0.0% 2.7%

This chart depicts the comparison of Year 1 and Year 5 motor function in the male population (alive at 

5 years post-injury), divided into age subgroups. Lighter colors indicate better outcomes than darker ones. 

As illustrated by the color patterns, most males were independent or had modified independence regardless 

of age or year post-injury. Less than 10% of males under age 50 needed supervision or assistance due to 

decreased motor function either at 1 or 5 years post-injury. Among males age 50-69, the proportion needing 

supervision or assistance due to motor function was also under 10% at Year 1, but 11.3% at Year 5. Among 

males age 70 and over, that proportion was 14.3% at Year 1 and 27.0% at Year 5.

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Traumatic Brain Injury Report l 32

CHANGE IN MOTOR FUNCTION BY SEX AND AGE FROM 

1 TO 5 YEARS POSTINJURY AMONG 5-YEAR SURVIVORS 

OF MODERATE-TO-SEVERE TBI*

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

90% 

100% 

DISTRIBUTION

FEMALE 

16-29 

YR 1 TO 5

FEMALE 

30-49 

YR 1 TO 5

FEMALE 

50-69 

YR 1 TO 5

FEMALE 

70+ 

YR 1 TO 5

MALE 

16-29 

YR 1 TO 5

MALE 

30-49 

YR 1 TO 5

MALE 

50-69 

 YR 1 TO 5

MALE 

70+ 

YR 1 TO 5

Improved 4+ Categories 0.3% 0.2% 1.0% 0.5% 0.6% 0.4% 0.3% 0.0%

Improved 2-3 Categories 1.6% 2.0% 0.8% 0.7% 2.1% 1.9% 0.8% 5.1%

Improved 1 Category 4.9% 6.7% 5.3% 6.9% 5.3% 6.0% 3.4% 5.2%

No Category Change 91.1% 88.2% 84.2% 56.0% 90.6% 87.5% 85.0% 71.4%

Declined 1 Category 1.4% 2.8% 7.8% 20.1% 1.2% 3.8% 5.6% 7.3%

Declined 2-3 Categories 0.3% 0.0% 0.2% 7.4% 0.2% 0.3% 4.0% 3.6%

Declined 4+ Categories 0.3% 0.0% 0.7% 8.3% 0.0% 0.0% 0.9% 7.5%

This chart depicts the proportion of the population (alive at 5 years post-injury) that improved or declined 

in motor function from Year 1 to Year 5, divided into sex and age subgroups. Females age 70 and over 

experienced the greatest decline in motor function, with 20.1% declining 1 category and 15.7% declining 2 or 

more. By contrast, 7.3% of males age 70 and over declined 1 category decline, with 11.1% declining 2 or more 

categories. The proportion of both females and males under age 50 improving in motor function was greater 

than those declining, but for both females and males age 50 and over the proportion declining was greater 

than those improving. 

*Note: Includes cases with moderate-to-severe TBI receiving inpatient rehabilitation between 2001-2007 and followed for five years through 2012.
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 33

METHODOLOGICAL APPENDIX

Excerpted with permission from:

John D. Corrigan, Jeffrey P. Cuthbert, Cynthia Harrison-Felix, Gale G. Whiteneck, Jeneita M. Bell, A. Cate Miller, 

Victor G. Coronado, Christopher R. Pretz. U.S. Population Estimates of Health and Social Outcomes 5 Years After 

Rehabilitation for Traumatic Brain Injury. J Head Trauma Rehabil. 2014. Vol. 29, No. 6, pp. E1–E9.

Recent publications by Corrigan and colleagues3 and Cuthbert and colleagues4 have provided a basis for 

deriving population estimates of persons 16 years and older in the United States who receive inpatient 

rehabilitation for a primary diagnosis of TBI. The Uniform Data System for Medical Rehabilitation8 and the 

American Medical Rehabilitation Providers Association’s eRehabData9 serve as intermediaries between 

inpatient rehabilitation facilities and the Centers for Medicare & Medicaid Services. These organizations 

receive information on all patients treated in a rehabilitation facility (whether or not the patient has Medicare 

funding) and forward these data to the Centers for Medicare & Medicaid Services. Data from as much as 92% 

of all inpatient rehabilitation facilities, and a still higher percentage of all patients, are collected and reported 

by these 2 programs.3 Corrigan and colleagues3 (for the years 2001-2007) and Cuthbert and colleagues4 (for 

the years 2001-2010) combined core data sets from the 2 intermediaries and compared the resulting U.S. 

population characteristics to the cohort enrolled in the TBI Model Systems National Database (TBIMS-NDB) 

for the same time periods. Both sets of analyses found overwhelming similarity between the U.S. population 

and the TBIMS cohorts after accounting for differences in the proportion of older adults. Among multiple 

individual differences and injury characteristics compared, important discrepancies were noted only for 1- 

to 9-day rehabilitation lengths of stay for both younger and older patients, and primary insurance and the 

proportion in the oldest age categories for the 65 years and older group. The minimal number of differences 

led to a common conclusion in both studies: with weighting, the TBIMS-NDB can be used to calculate 

population-level estimates for persons older than 15 years who received acute inpatient rehabilitation for a 

primary diagnosis of TBI in the United States.3,4 While population characteristics can be directly extracted from 

the combination of the Uniform Data System for Medical Rehabilitation and eRehabData data sets, only a 

limited number of variables are available, and no information is collected beyond rehabilitation discharge. 

The ability to extrapolate population estimates from the TBIMS-NDB allows a richer array of characteristics 

to be estimated, including outcomes post-injury, at 1, 2, 5, and every 5 years thereafter. The TBIMS-NDB 

includes medical record–verified cases of moderate and severe TBIs admitted for inpatient rehabilitation 

at a TBIMS center.10

The National Institute on Disability, Independent Living and Rehabilitation Research has funded the TBIMS 

program since 1987. Central to this program is a standardized, longitudinal database for studies of TBI 

treatment and outcomes started in 1987.11 In the TBIMS-NDB, TBI is defined as damage to brain tissue 

caused by an external mechanical force as evidenced either by medically documented loss of consciousness 

or posttraumatic amnesia due to brain trauma or by objective neurological findings that can be reasonably 

attributed to TBI on physical examination or mental status examination. In addition to having incurred a TBI 

meeting the aforementioned definition, additional inclusion criteria are as follows: (1) meet at least 1 of the 

following criteria for moderate-to-severe TBI: posttraumatic amnesia greater than 24 hours, trauma-related 

intracranial neuroimaging abnormalities, loss of consciousness exceeding 30 minutes, or a Glasgow Coma 

Scale score in the emergency department of less than 13 (unless due to intubation, sedation, or intoxication); 

(2) be at least 16 years of age at the time of injury; (3) present to an acute care hospital within 72 hours of 

injury; (4) receive both acute hospital care and comprehensive rehabilitation in a designated brain injury 

inpatient unit within the TBIMS; and (5) provide informed consent to participate or have a proxy provide 

consent.10 Data are recorded during inpatient rehabilitation and subsequently during follow-up interviews 

at 1, 2, and 5 years post-injury and every 5 years thereafter. The TBIMS data collection protocol uses a “best 

source” policy for interviewing a proxy when the individual is not able to provide valid information.10
Traumatic Brain Injury Report l 34

Measures that require reporting of a subjective state (e.g., life satisfaction, emotional state) are collected only 

from the individual with a TBI. As of March 31, 2016, the TBIMS-NDB contained 14,633 cases and had a followup rate of 82% for follow-up interviews conducted up to 25 years post-injury; 83% for just those at 5 years.

The current report used the Corrigan and colleagues 2001-2007 compilation of the U.S. population receiving 

rehabilitation for TBI to weight the 4,838 TBIMS-NDB cases admitted and discharged between October 1, 

2001, and December 31, 2007 (with 1 and 5 year post-injury follow-up data collected between 2002 and 

2013).12 In the first step, the TBIMS-NDB cases were weighted using raking, an iterative proportional weighting 

procedure that repeats until a sample distribution closely matches that of a larger population across numerous 

population characteristics simultaneously.13 In this first raking and weighting procedure, sample distributions 

were the characteristics of the TBIMS-NDB, and the population values were the categorical characteristics of 

the U.S. TBI Rehabilitation population included in the article by Corrigan and colleagues.12 Variables included 

as part of this raking and weighting procedure were age, sex, race/ethnicity, marital status, primary payment 

source, rehabilitation length of stay, and FIM motor and cognitive scores. Within the TBIMS-NDB, missing 

values for variables were rare (<10%); however, those individuals with missing data across any of these 

variables had the missing value imputed using expectation maximization14 prior to the implementation of 

the raking procedure. At the completion of raking, all case weights were evaluated using weight trimming, 

a process in which weights of extreme values are truncated to less extreme values (e.g., 1%-5%), with the 

intent of reducing the mean squared error for outcomes of interest. For these analyses, weight trimming was 

not found to reduce the mean squared error for any of the outcomes; thus, the weights were applied in their 

original configuration. In the TBIMS-NDB weighted sample, 20% expired by their 5th anniversary of injury. 

For the supervision, cognitive function, and motor function charts in this report, surviving cases were further 

limited to individuals with complete follow-up data at all time points and a second round of raking and 

weighting was used to adjust the remaining cases with complete follow-up data to the characteristics of 

all surviving cases. All raking and weight trimming analyses were completed with SAS (version 9.3), using 

the IHB raking macro.15
Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation l 35

REFERENCES

1. Whiteneck GG, Cuthbert JP, Corrigan JD, Bogner JA. Prevalence of Self-Reported Lifetime History of 

Traumatic Brain Injury and Associated Disability: A Statewide Population-Based Survey. The Journal 

of head trauma rehabilitation. 2016;31(1):E55-E62.

2. Corrigan JD, Yang J, Singichetti B, Manchester K, Bogner JA. Lifetime Prevalence of TBI with Loss of 

Consciousness. Journal of Epidemiology and Community Health. In Review.

3. Corrigan JD, Cuthbert JP, Whiteneck GG, et al. Representativeness of the traumatic brain injury model 

systems national database. J Head Trauma Rehabil. 2012;27(6):391–403.

4. Cuthbert J, Corrigan JD, Whiteneck GG, et al. Extension of the representativeness of the traumatic brain 

injury model systems national database: 2001 to 2010. J Head Trauma Rehabil. 2012;27(6):E15–E27.

5. Wilson JT1, Pettigrew LE, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the 

extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma. 1998 Aug;15(8):573-85.

6. Boake C. Supervision rating scale: a measure of functional outcome from brain injury. Arch Phys Med 

Rehabil. 1996. 77(8): 765-772.

7. Centers for Medicare & Medicaid Services. “Section 3: The FIM Instrument” in The Inpatient Rehabilitation 

Facility-Patient Assessment Instrument (IRF-PAI) Training Manual: Effective 10/01/2014. 

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/IRFPAI.html. 

Accessed July 3, 2017.

8. UDS. Uniform Data System for Medical Rehabilitation. http://www.udsmr.org. Accessed July 3, 2017.

9. American Medical Rehabilitation Providers Association. eRehabData. com. https://wwwv.erehabdata.

com. Accessed July 3, 2017.

10. TBI Model Systems National Data and Statistical Center. Traumatic brain injury model systems national 

database. http://www.tbindsc.org. Accessed July 3, 2017.

11. Dijkers MP, Harrison-Felix C, Marwitz JH. The traumatic brain injury model systems: history and 

contributions to clinical service and research. J Head Trauma Rehabil. 2010;25(2):81–91.

12. Corrigan JD, Cuthbert JP, Harrison-Felix, C Whiteneck GG, Bell JM, Miller AC, Coronado VG, Pretz CR. 

U.S. Population Estimates of Health and Social Outcomes 5 Years After Rehabilitation for Traumatic Brain 

Injury. J Head Trauma Rehabil. 2014. Vol. 29, No. 6, pp. E1–E9.

13. Kalton G, Florres-Cervantes I. Weighting methods. J Off Stat. 2003;19(2):81–97.

14. Dempster AP, Lair NM, Rubin DB. Maximum likelihood from incomplete data via the EM algorithm. 

J R Stat Soc. 1977;39(1):1–38.

15. Izrael D, Hoaglin DC, Battaglia MP. A SAS macro for balancing a weighted sample. Paper presented at: 

Proceedings of the Twenty-fifth Annual SAS users Group International Conference; 2000; Indianapolis, IN, 

Paper 258.
CS 292440

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Injury Prevention and Control

Administration for Community Living (ACL) 

National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR)

www.cdc.gov/TraumaticBraininjury